Concurrent Eclampsia, HELLP (Hemolysis, Elevated Liver Enzymes, and Low Platelets) Syndrome and Peripartum Cardiomyopathy in a Primigravida: A Case Report.

Hypertensive disorders of pregnancy can rapidly progress to multi-organ failure. Eclampsia and HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome are obstetric emergencies, while peripartum cardiomyopathy (PPCM) is a rare but potentially fatal cause of heart failure in late pregnancy and the postpartum period. We report the case of a critically ill 32-year-old primigravida at 35 weeks' gestation with treated hypothyroidism who presented with generalized tonic-clonic seizures, severe hypertension, and pulmonary edema. Laboratory evaluation demonstrated thrombocytopenia and transaminitis with markedly elevated lactate dehydrogenase (LDH), consistent with HELLP syndrome. Obstetric assessment revealed a closed cervical os with the vertex above the brim, and bedside ultrasound confirmed a viable fetus with good cardiac activity and no evidence of placental abruption. Targeted echocardiography showed global left ventricular hypokinesia with severe systolic dysfunction (estimated ejection fraction ~25%) and a dilated left ventricle with moderate (grade II) mitral regurgitation and diastolic dysfunction. After stabilization with airway protection, magnesium sulfate, antihypertensive therapy, diuretics, and inotropic support, an emergency lower-segment cesarean section was performed, resulting in the delivery of a live female baby. Postoperatively, the patient required intensive care, blood product transfusion for HELLP syndrome, and guideline-directed heart failure therapy. Serial echocardiography showed improvement in ejection fraction to 45% on postoperative day two and 58% before discharge. This report underscores the diagnostic overlap between preeclampsia-spectrum pulmonary edema and PPCM, and highlights the role of bedside echocardiography and multidisciplinary critical care in optimizing maternal outcomes.